| NPI | 1730459397 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BARY ROBB REDFORD Owner 208-604-0098 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2012-01-12 |
| Last Update Date | 2012-01-12 |